Tel: 021 948 2152

Fax: 021 948 1630 Cellular: 082 475 3958

E-mail: gardiner@gstone.co.za

132B Durban Road, Prospect Place, Bellville, 7530

ORDER FORM for Niche Plaques

Date Contact Person-Title and Initials Contact Person-Surname
Complete Address Contact Details
Home
Office
Fax
Mobile
Email
Community Address Space Number
Write the desired inscription in the open space provided, indicate letter type and symbols
Lines Letter Type
1
2
3
4
5
6
7
8
9
10
Mark the desired Symbol
Flowerholder
Yes
No
Should a space be left for an additional inscription?
Yes No
Left Right
Bottom Top
Should Gardiner Stone collect the ashes from the undertaker on your behalf?
Yes No Name of Undertaker Contact Person Telephone
Should Gardiner Stone arrange for a wooden chest? Yes No
Do you want to be present during the placement of the ashes and tablet? Yes No
Confirm date and time with us for placement of ashes and tablet Date: Time:
Send a photo of the complete work to this email address